Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Prescription costs wikipedia , lookup
Pharmacognosy wikipedia , lookup
Adherence (medicine) wikipedia , lookup
Pharmacogenomics wikipedia , lookup
Electronic prescribing wikipedia , lookup
Polysubstance dependence wikipedia , lookup
National Institute for Health and Care Excellence wikipedia , lookup
TRUST MEDICINES FORMULARY This Formulary details those psychotropic medicines that may be prescribed within the Trust (on hospital prescriptions and FP10s) and recommended to be prescribed across South West London and should be read in conjunction with the Shared care for Psychotropics with Primary care and the ‘off-label’ policies. The Formulary contains: formulations that are available within the Trust prescribing restrictions / guidelines that apply to that medicine within the Trust additional information pertinent to the safe & effective use of the medicine Medicines in the same order as the British National Formulary (BNF), with headings Only psychotropic medicines (see local Hospital Formularies for medicines for physical complaints). Nicotine replacement treatments follow Wandsworth CCG formulary (includes bupropion and varenicline and other treatments) Compliance with NICE Technology Appraisal Guidance. Non-formulary psychotropic medicines Agomelatine Aripiprazole Depot Asenapine Duloxetine Escitalopram (except OCD/BDD) Loxapine inhalation Lurasidone Olanzapine palmoate Oxazepam Paliperidone (oral) Medicines removed from the formulary: Benperidol -July 2010 Benzatropine -July 2011 Chloral hydrate -Nov 2009 Chlormethiazole –Sept 2015 Concerta (except 27mg) –Dec 2015 Dosulepin (Dothiepin) -2007 Droperidol -2001 Melatonin (Unlicensed) –July 2011 Nefazodone -January 2003 Olanzapine short acting inj. -Dec 2013 Orphenadrine -Sept 2013 Promazine -Dec 2013 Reboxetine -July 2011 Risperidone long-acting injection April 2011 Ritalin-SR -July 2011 Temazepam -Feb 2014 Thioridazine - 2005 Zotepine - July 2011 Medicines Added to the Formulary since April 2015: Lisdexamfetamine –Oct 2015 Nutrition & dietetic products-Apr 2015 Vortioxetine-Feb 2016 Xenidate®-Apr 2015 Further advice & Information Contact your local Mental Health Pharmacist or Medicines Information on 020 3513 6829 for help and advice. The Trust has a formulary policy (available on the Trust’s intranet and website), and application forms for non-formulary medicines for specific patients (SDTC2) or for inclusion in to the formulary (SDTC1) . Trust Prescribing guidance is available on the Medicines and Prescribing subsite, the Policies section of the intranet or website. See the BNF, BNFc and Manufacturers Summary of Product Characteristics for full prescribing details. Numbering refers to eBNF. DTC Feb 2016 * If clinically indicated or another preparation if the patient insists. 3.4.1 Sedating antihistamines Medicine Formulations Promethazine hydrochloride tablet 10mg, 25mg liquid 5mg / 5ml injection 25mg/mL 4.1 Hypnotics & Anxiolytics Nitrazepam tablet 5mg, liquid 2.5mg / 5ml Non-benzodiazepine hypnotics & other sedatives Zopiclone tablet 3.75mg tablet 7.5mg Zolpidem Melatonin 4.1.2 Anxiolytics Diazepam Chlordiazepoxide Lorazepam DTC Feb 2016 tablet 5mg tablet 10mg tablets 2mg MR (Circadin®) tablet 2mg, 5mg, 10mg. liquid 2mg/5ml, 5mg/5ml. injection emulsion 5mg/ml, rectal solution 5mg, 10mg capsule 5mg, 10mg tablet 1mg, 2.5mg injection: 4mg /1ml. 2mg/1ml (does NOT require dilution)* Restrictions *1st line *2nd line after zopiclone School-age children with developmental disability. Additional information See Trust policy TWC21x Use with caution & at lower dosage in the elderly (see BNF) See Trust policy TWC21x Controlled Drug See NICE TA77: Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomia Controlled Drug See NICE TA77 Unlicensed formulations from Hospital only. Injection (emulsion) intravenous (IV) only For alcohol detoxification regimens only IM gluteal injection only or deltoid when safe to do so * If clinically indicated or another preparation if the patient insists. 4mg/1ml injection: dilute 1:1 with water for injection / sodium chloride 0.9% Imported from outside the EU. 4.2 Medicines used in psychoses and related disorders 4.2.1 Antipsychotic Medicines Medicine Chlorpromazine Flupentixol dihydrochloride Haloperidol Sulpiride Trifluoperazine Zuclopenthixol acetate (“Clopixol Acuphase”) Zuclopenthixol dihydrochloride Atypical Antipsychotics Amisulpride Aripiprazole Clozapine DTC Feb 2016 Formulations tablet 10mg, 25mg, 50mg, 100mg liquid 25mg/5ml, 100mg/5ml 3mg tablet capsule 500microg, tablet 1.5mg, 5mg, 10mg liquid 5mg/5ml, 10mg/5ml injection 5mg/1ml tablet 200mg, 400mg liquid 200mg / 5ml tablet 1mg, 5mg** liquid 5mg/5ml injection 50mg, 100mg Restrictions See Trust policy TWC21c. NOT to be used for night sedation. Hospital only: mania in Children Additional information Pre-treatment ECG required 200mg tablets are 1st line **Manufacturing delays frequent consider switching to another medicine. Hospital only. For use in patients requiring or may require repeated IM injections and are refusing oral medicines tablet 2mg,10mg, 25mg tablet 50mg, 200mg, 400mg liquid 100mg / 1ml tablet 5mg, 10mg, 15mg orodisp tab. 10mg, 15mg injection 7.5mg in 1ml tablet 25mg, 100mg (Zaponex) liquid 50mg/mL (Denzapine) *Not 1st line for any indication Max recommended 1015mg/day in schizophrenia See Trust Clozapine Guide * If clinically indicated or another preparation if the patient insists. Use liquid only if doses are <2.5mg/day See NICE TA213: Aripiprazole for the treatment of schizophrenia in people aged 15 – 17 years See NICE TA292: Aripiprazole for treating moderate to severe manic episodes in adolescents with bipolar I Monitoring systems used: Zaponex Treatment Access System (ZTAS) for tablets. Denzapine Monitoring Service (DMS) for liquid. Medicine Olanzapine Quetiapine Risperidone (oral) Formulations tablet 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg dispers. tablet 5mg, 10mg, 15mg tablet 25mg, 100mg, 150mg, 200mg, 300mg M/R tablets 50mg, 200mg, 300mg, 400mg tablet 500microg, 1mg, 2mg, 3mg, 4mg, 6mg dispers. tablet 1mg, 2mg, 3mg, 4mg. liquid 1mg / 1ml 4.2.2. Antipsychotic Depot Injections Flupenthixol decanoate 20mg/1ml, 40mg/2ml, 50mg/0.5ml, 100mg/1ml, 200mg/1ml. Fluphenazine decanoate 12.5mg/0.5ml, 25mg/1ml, 50mg/0.5ml &100mg/1ml Haloperidol decanoate 50mg/1ml, 100mg/1ml Pipotiazine palmitate 50mg/1ml, 100mg/2ml Zuclopenthixol decanoate 200mg/1ml, 500mg/1ml Paliperidone palmitate 50mg, 75mg, 100mg, 150mg DTC Feb 2016 Prescribing restrictions Orodispersible for dyspahgia or supervised administration only Additional information Requires twice daily dosage 1st line atypical antipsychotic. Orodispersible for dyspahgia or supervised administration only For community team use for supervised administration only, not for discharge. Optimum oral dosage 4-6mg per day in schizophrenia. See TWC21b for administration details Not for new initiations. Schizophrenia: either side effects from current depot, compliance problems with oral atypical or at patient request * If clinically indicated or another preparation if the patient insists. Complete monitoring form before prescribing. Complete SDTC2 if patient does not meet Trust prescribing criteria. 4.2.3 Antimanic Medicines Medicine Formulations Prescribing restrictions Carbamazepine Lamotrigine Sodium valproate Lithium carbonate Lithium citrate Semisodium valproate “Priadel” tablet MR 200mg, 400mg Liquid 10.8mmol Li / 5ml (“Li-liquid”) tablet e/c 250mg, 500mg 2nd line valproate preparation 4.3 Antidepressant Medicines 4.3.1Tricyclic & related antidepressant Medicines Amitriptyline tablet 10mg, 25mg, 50mg liquid 50mg / 5ml Clomipramine caps 10mg, 25mg, 50mg Imipramine tablet 10mg, 25mg liquid 25mg / 5ml Lofepramine tablet 70mg liquid 70mg / 5ml Nortriptyline tablet 10mg, 25mg DTC Feb 2016 * If clinically indicated or another preparation if the patient insists. Additional information See Section 4.8 - Antiepileptic Medicines below See Section 4.8 - Antiepileptic Medicines below See Section 4.8 - Antiepileptic Medicines below Should not be used during pregnancy and in women of child-bearing potential unless clearly necessary i.e. in situations where other treatments are ineffective or not tolerated (MR = modified release) 10.8mmol/5ml = 400mg lithium carbonate Prescribe as “Depakote – semisodium valproate” to avoid confusion with Epilim Should not be used during pregnancy and in women of child-bearing potential unless clearly necessary i.e. in situations where other treatments are ineffective or not tolerated Trimipramine tablet 10mg, 25mg capsule 50mg Trazodone capsule 50mg,100mg liquid 50mg / 5ml 4.3.2 Monoamine – oxidase inhibitors (MAOIs) Phenelzine tablet 15mg Isocarboxazid tablet 10mg Tranylcypromine tablet 10mg Reversible MAOIs Moclobemide tablet 150mg 4.3.3 Selective serotonin re-uptake inhibitors Medicine Formulations Citalopram Fluoxetine Paroxetine Sertraline Escitalopram tablet 10mg, 20mg capsule 20mg liquid 20mg / 5ml tablet 20mg, 30mg liquid 10mg / 5ml tablet 50mg, 100mg Tablet 5mg, 10mg, 20mg 4.3.4 Other antidepressant Medicines Mirtazapine orodispersible tablet 15mg, 30mg, 45mg Venlafaxine tablet 37.5mg, 75mg MR caps (hospital only) MR 75mg, 150mg. MR tabs (community only) Vortioxetine Tablet 5mg, 10mg, 20mg DTC Feb 2016 Not first-line treatment Not first-line treatment Not first-line treatment Not first-line treatment BNF: “less suitable for prescribing” BNF: “less suitable for prescribing” BNF: “less suitable for prescribing” Not first-line treatment Prescribing restrictions Additional information 1st line antidepressant 1st line antidepressant For use on “National OCD service recommendation” only Not first-line treatment Not first-line treatment MR = modified release, used only where the patient chooses *Not first-line treatment Restricted to major depressive episodes in adults whose condition has responded inadequately to two antidepressants within the current episode. See NICE TA367 * If clinically indicated or another preparation if the patient insists. 4.4 Central Nervous System Stimulants and other Medicines used for attention deficit hyperactivity disorder See TWC21s Atomoxetine capsule 10mg, 18mg, 25mg, 40mg, Specialist ADHD *Third line, after methylphenidate and 60mg prescriber initiation only. dexamfetamine (unless there are anxiety issues or risk of diversion) See NICE TA98 Methylphenidate, atomoxetine and dexamfetamine for ADHD in children and adolescents Dexamfetamine sulphate tablet 5mg Controlled Drug See NICE TA98 Lisdexamfetamine capsules 30mg, 50mg, 70mg Controlled Drug, 2nd line Methylphenidate tablet 5mg, 10mg Controlled Drug hydrochloride See NICE TA98 Methylphenidate Xenidate, Concerta 27mg (only), Controlled Drug hydrochloride Equasym , Medikinet XL *1st line preparation, Xenidate See NICE TA98 4.8 Antiepileptics (treatment / prevention of psychiatric symptoms) Carbamazepine tablet 100mg, 200mg, 400mg Licensed for “prophylaxis of bipolar tablet MR 200mg, 400mg disorder not responsive to lithium.” liquid 100mg / 5ml Recommended in NICE Bipolar guideline Clonazepam tablet 500microgram, 2mg Use other than for epilepsy is an unlicensed indication Lamotrigine tablet 25mg, 50mg, 100mg, 200mg Use other than for epilepsy is an dispers. tab. 5mg, 25mg, 100mg unlicensed indication Recommended in NICE bipolar guideline Midazolam Buccolam 2.5mg, 5mg, 7.5mg and Available for conscious sedation 10 mg oromucosal solution according to Trust guidelines Pregabalin Capsules 25mg, 100mg, 300mg 3rd line as per NICE for GAD, initiation form to be completed. Sodium valproate tablet 100mg, 200mg, 500mg 1st line valproate Endorse with ‘Epilim’ to avoid errors. tablet MR 200mg, 300mg, 500mg preparation Should not be used during pregnancy and liquid 200mg / 5ml in women of child-bearing potential unless clearly necessary i.e. in situations where other treatments are ineffective or not tolerated DTC Feb 2016 * If clinically indicated or another preparation if the patient insists. 4.9 Medicines used in parkinsonism and related disorders 4.9.2 Antimuscarinic Medicines used in parkinsonism Medicine Formulations tablet 5mg liquid 5mg / 5ml injection 5mg / 1ml Trihexyphenidyl (Benzhexol) tablet 2mg, 5mg 4.10 Medicines used in substance dependence Alcohol dependence Acamprosate tablet 333mg Prescribing restrictions Additional information Procyclidine Disulfiram tablet 200mg Naltrexone tablet 50mg Nalmefene tablet 18mg Opioid dependence Buprenorphine DTC Feb 2016 tablet sublingual 8mg, 2mg & 400microgram See blue book & Trust policy Initiation by Addictions teams only Initiation by Addictions teams only Initiation by Addictions teams only May be initiated by GPs only. Patient must be engaged with a form of psychosocial support provided by Community Alcohol team or similar to initiate this medicine. See NICE TA115: Naltrexone for the management of opioid dependence See NICE TA325: Nalmefene for reducing alcohol consumption in people with alcohol dependence Initiation by Addictions teams only Ensure opiate detox brand is used (i.e.not Temgesic analgesic) Controlled Drug See NICE TA114 Methadone and buprenorphine for the management of opiod dependence * If clinically indicated or another preparation if the patient insists. Buprenorphine/naloxone tablets 2mg/500microrams 8mg/2mg Initiation by Addictions teams only Lofexidine tablet 200micrograms Initiation by Addictions teams only Methadone Methadone liquid “mixture” 1mg /1ml (sugar free) Tablet 5mg Naltrexone tablet 50mg DTC Feb 2016 Substitution treatment for opiod dependence in the framework of medical psychological and social treatment for patients over 15yrs who have agreed to treatment. Addictions teams only Initiation by Addictions teams only * If clinically indicated or another preparation if the patient insists. Those with a history crushing and injecting tablets Known to divert prescribed medication Unable to comply with supervised consumption of buprenorphine in first 3 months of treatment due to work or child care commitments or physical disability Transferred from another service already initiated on Suboxone®. Controlled Drug Controlled Drug See NICE TA114 Controlled drug, as an option for overseas travel where large volumes of methadone liquid would be impractical See NICE TA114 See TA115 Naltrexone for the management of opioid dependence Medicine Formulations Prescribing restrictions 4.11 Medicines for dementia Donepezil tablet 5mg, 10mg orodisp tablet 5mg, 10mg Older peoples & LD teams only Galantamine tablet 4mg, 12mg Older peoples & LD teams only Older peoples & LD teams only Rivastigmine capsule 1.5mg liquid 2mg / 1ml patch 4.6mg/24hours & 9.5mg /24 hours Memantine Tablet 10mg, 20mg Liquid 5mg/pump 9.6.7 Multivitamin preparations Sanatogen Gold tablet 1.3.2 Selective antimuscarinics Pirenzapine tablet 50mg See TWC21q shared care for antidementia medicines 1st Line See NICE TA217 Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimers disease See NICE TA217 See NICE TA217 Older peoples & LD teams only See NICE TA217 Eating disorders inpatient service only For use alongside an emergency diet in patients at risk of re-feeding syndrome Antipsychotic induced sialorrhoea, 2nd line See Trust ‘off-label’ list appendix 1 of TWC21k. Imported from within the EU. See Trust ‘off-label’ list appendix 1 of TWC21h. Hyoscine hydrobromide tablet 500micrograms Antipsychotic induced sialorrhoea, 1st line Atropine 1% eyedrops Antipsychotic induced sialorrhoea, used in water or sublingually, 2nd line DTC Feb 2016 Additional information * If clinically indicated or another preparation if the patient insists. See Trust ‘off-label’ list appendix 1 of TWC21h. Nutritional feeds used by the inpatient mental health service only: Tube feeds: Nutrison Standard 1.0 kcal/ml Nutrison Energy 1.5k kcal/ml Nutrison Multifibre 1.0 kcal/ml Nutrison Energy Multifibre 1.5 kcal/ml. Oral Nutrition Support products Skandishake Fortisip Fortisip Multi Fibre Fortisip Compact Fortisip Compact Fibre Fortimel Fortisip Yoghurt Style Fortisip Savoury Multi Fibre Fortijuice Calogen Calogen Extra shot Forticreme Complete Fortisip Fruit Dessert Complan Shake Thickener/thickened products Nutilis clear Nutilis Complete Complan DTC Feb 2016 * If clinically indicated or another preparation if the patient insists.